Gift Certificate Request


Name of Person receiving Gift:
Name or Organization giving Gift:
Gift Certificate Type:
If Other - Please provide special occasion:
Amount on Gift Certificate:
  30 Minutes / $40
  60 Minutes / $75
  90 Minutes / $100
  5 Session Performance Package  / $350
  Current methods of payment is cash, check, and Paypal (credit card transaction). 
   
   
Person purchasing Gift Certificate:
Address to send Invoice:
City, State, Zip..
Telephone Number:
   
Email:
   
Special Instructions (*):
  (*) - Special instructions:  how is the gift certificate to be provided?  Do we send it to the person purchasing the gift, send it to the person receiving the gift?  Provide address if we need to send it to the person receiving the gift.
   
Date needed?
   
   
Current methods of payment is cash, check, and Paypal (credit card transaction).